Syncope: isolated syncope had a benign prognosis.

Clinical bottom line (level 1b)

  1. Isolated syncope was uncommon in both men and women.
  2. There was no clear increased risk of dying or having a stroke or myocardial infarction.
Savage et al: Stroke 1993; 16: 626-629
Expires October 2004

The study

Prospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: community, USA

5209 patients (aged range 30 to 62 years; mean 46, 55% female) without cardiovascular disease

Excluded if
  • syncope prior to enrolment
  • aged < 35 on enrolment






    • 95% followed for 26 years
    Outcomes studied:
  • syncope in men (isolated syncope: no evidence of neurologic or cardiac disease based on blinded case-review by neurologist and cardiologist)
  • syncope in women
  • stroke or MI
  • death

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    syncope in men 26 years 71/2336 3.0%
    (2.3% to 3.7%)
    syncope in women 26 years 101/2873 3.5%
    (2.8% to 4.2%)
    stroke or MI 26 years / %
    (% to %)
    death 26 years / %
    (% to %)

    prognostic factor for
    stroke or MI     		time to outcome unadjusted RR
    (95% CI)
    presence of isolated syncope 26 years 0.70-1.14
    ( to )

    prognostic factor for
    death     		time to outcome unadjusted RR
    (95% CI)
    presence of isolated syncope 26 years 0.62-0.73
    ( to )

    Comments

    1. Recurrent syncope warrants further investigation.
    2. Not clear enough on how cardiac/neurological causes were ruled out.
    3. The study reported that there was no significant difference in stroke, MI or mortality between patients with or without syncope but gave no further data.

    Citation

    1. Savage DD, et al: Epidemiological features of isolated syncope: the Framingham Study. Stroke 1993; 16: 626-629
    Contributor: Bob Phillips and Chris Ball, October 2000
    Reviewer: Santiago Alvarez Montero

    Clinical Question.
    Patient without cardiovascular disease
    Intervention or Exposure prevalence
    Outcome isolated syncope